Therapists Can Be Wrong

I’m writing this because I know it happens more frequently than everyone would like.

Therapists can be wrong.

They can make mistakes, even big ones and these mistakes can have consequences.

Diagnoses can be challenging to make. We know that a diagnosis is helpful for classification purposes, it can help decide a course of treatment. Insurance companies generally demand one. And specialists who devote their careers to one area of mental illness can often become experts in successful treatment.

But it isn’t always easy to get an accurate diagnosis, DSM or not. Bi-polar disorder can be confused with borderline personality disorder or depression. Some physical illnesses may lead to symptoms of depression and/or cause depression. Personality disorders may be difficult to isolate as some patients might not accurately and honestly portray the signs and symptoms. Addiction may not be disclosed and may lead to misdiagnosis.

Like all fields of knowledge, mental health is imperfect and we must be tolerant when genuinely compassionate experts with real training, skills, and knowledge err on challenging cases. But sometimes with even just minor care and concern, serious errors are preventable, as in the following case, excerpted from our book, Therapy Revolution: Find Help, Get Better, and Move On (HCI.)

Denise, an editor of a scholarly journal, is from Boston. She entered therapy in order to work on fighting the inertia she felt after the break up of her marriage. She wanted to find a new relationship and explore career options, but hesitated to make the effort because of the sadness the divorce triggered in her.

Therapy had helped her brother cope with some problems, so she thought she should give it a try. Lori, her newfound therapist was personable and caring, but after only the most cursory evaluation never bothered to create a treatment plan with Denise. After a few sessions, Lori began to ask Denise more and more questions about her childhood, which Denise felt was really going off track, but still Denise hesitated to confront her. Several months later Lori was telling Denise that she needed to work on her anger issues, and that the grief she felt over the break up of her marriage was really disguised anger.

When Denise, an honest individual expressed puzzlement at this proclamation, the therapist told her that Denise repeatedly mentioned her anger and even rage during their first couple of sessions and had specifically asked to work on these issues.

Denise insisted she never said any such thing. She remembered specifically that she told Lori she was somewhat sad and disappointed. Yet, Lori kept on insisting she did mention anger.

Finally, after three more sessions spent in fruitless back and forth disagreement Denise decided that she wanted to see another therapist. She came to a colleague of mine who, after a comprehensive evaluation, worked on a treatment plan with Denise which focused on addressing her lingering (though minor) sadness (not depression), and her desire for a new career. Denise now had a written treatment plan. Both Denise and her new therapist were able, with quite a bit of accuracy, to remember why Denise entered therapy in the first place.

Without harping on the importance of the treatment plan (you can read about it often in the Therapy Soup blog) it’s obvious that this therapist wasn’t listening and/or wasn’t taking accurate notes. Listening is among the most important skills a therapist can have. It isn’t easy–actively listening to clients isn’t a passive activity–it’s hard work.

Everyday therapy patients are given compassionate, effective care by therapists around the world. If you’re a therapist and you make an error, own up and try to rectify it. Listen to what your patient says, sometimes, and if a patient says they are feeling sad, don’t always assume it’s anger, or depression, or a disorder. To paraphrase, sometimes sadness is just sadness.

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